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Sleep and Insomnia

What is Insomnia?

Insomnia can be explained by the difficulty you may have falling asleep or staying asleep. People who suffer from insomnia will often experience the following symptoms: sleepiness, fatigue, low energy, a hard time concentrating, and low performance at work.

Unfortunately, this is more and more common in adults. The National Institute of Health estimates that around 30% of the general population has sleep disruption complaints, and approximately 10% have associated the symptoms of daytime functioning.


Sleep disorders can be treated based on the symptoms and their causes. While some are treated with behavioral techniques (relaxation exercises or breathing exercises), others need several kinds of medication. Soporifics and tranquillizers are often used to help you sleep better and feel well rested. As a direct consequence, it will improve your energy, mood and concentration levels. Another option is Melatonin. Melatonin supplements are often used and will help the body to go into a resting state, allowing you to sleep more and have a quality rest.

In the years when I studied at a medical institute (this was about 40 years ago), sleepless nights on duty were considered the norm. Sometimes shifts began at 8 in the morning and lasted 24 hours. Often, my colleagues and I continued to work until the evening of the next day, after which, returning home, we went to sleep right in our clothes. Such "heroic" actions were a kind of pride since the profession of a doctor was associated with selfless work, the character of an "iron man" who did not perceive a time frame.

Moreover, sleepless nights were considered as attributes of the success of creative personalities: writers, composers, artists. I remember how the style of the prolific French writer Honore de Balzac was exalted, who stimulated his sleepless work by daily consumption of 50 cups of coffee, often on an empty stomach. He colorfully described how caffeine “shoots to the very brain, helping to thoroughly display the character of the book’s character, elegantly lining sheets of paper with an ink carpet.” Balzac for 15-16 hours a day was engaged in writing. He had the strength to work in such a rhythm for 20 years, six of which he devoted to 16 volumes of the famous prose, which he called "Human Comedy". 

In addition to creative successes, history knows a lot of suffering due to insomnia and other sleep disorders. For example, such reflections can be found in Shakespeare, whose Henry IV, tormented by insomnia due to remorse after taking the throne, laments: "Oh dream, oh sweet dream! Our guardian, how did I scare you that you don’t want me to mix eyelashes? " In the modern world, more than 10 percent of the world's population suffers from insomnia. Sleep disorders are associated with dangerous car driving and injuries at work increased risks of Alzheimer's disease, cancer, diabetes, stroke, cardiovascular and many other diseases.

The ancient Greek tyrant Dionysius, who ruled the kingdom of Heracles on the island of Crete in the 4th century BC, suffered from obesity and drowsiness, and to such an extent that he instructed his servants to wake him periodically when he stopped breathing due to deep sleep. It is now known that this condition is called apnea, and it is characterized by sudden awakening due to respiratory arrest due to airway blockage. Sleep apnea is found in 2-3 percent of modern people, and among those who are not obese. It can lead to heart attacks and strokes due to impaired oxygen supply to the heart and brain, as well as accelerate the degradation of cognitive functions.

Today, in the medical world, much more attention has been paid to sleep problems, since it has become apparent that sleep disturbances cause serious disturbances in the body, and full sleep is one of the key conditions for health and quality of life. If earlier insomnia was often associated with depression or anxiety, and drowsiness with laziness and lack of initiative, now doctors are trying to better understand the physiological causes of such conditions, which often require in-depth and thoughtful diagnosis and treatment. Equipped sleep laboratories began to appear “to the teeth” in the world, where doctors can now study in detail how sleep disorders are associated with Parkinson’s disease, esophageal reflux, traumatic brain injuries, as well as hormonal imbalances due to problems with the thyroid gland and pituitary gland.

Sleep is a universal need and a free resource

Most adults are recommended 7-8 hours of continuous sleep per day. Babies can sleep about 16 hours a day. Preschool children need an 11-hour sleep, and those who go to school should sleep about 10 hours a day. For teens, 9-hour sleep is quite adequate.

It would seem that sleep is available to any person on earth - this is a free resource. Why, then, sleep problems in so many people cause so much anxiety and frustration? Why are we forced to pay so much attention to this issue, trying to understand and instruct our children on how to sleep? And why, despite so much effort, do sleep problems still remain outside our control?

Quality sleep in our turbulent times becomes a symbol of well-being and even privileged status. In 2017, scientists involved in the genetic mechanisms of the so-called circadian rhythm, which determines the regularity of the change in sleep and wake periods, were awarded the Nobel Prize in physiology and medicine. Although today we know much more about the mechanisms of sleep than before, it nevertheless remains one of the most mysterious phenomena in our daily lives.

Sleep has been present on earth for 500 million years, and all forms of life need it - from plants, insects, marine life and amphibians to birds and mammals. Lions and tigers sleep on average about 15 hours a day, while bats sleep more than 19 hours. Dolphins are characterized by the fact that they sleep half of the brain. This means that the other half is constantly awake. The same is true for fish, for which constant wakefulness of at least half of the brain is vital in order to constantly stay afloat.

There is a theory that Homo Sapiens appeared after the predecessor of Homo Erectus (Homo erectus) came down from the trees and was able to enjoy a blissful dream, during which reasonable thoughts began to come. Evolution has transformed this opportunity into a creative revolution, which has become a feature of modern man that distinguishes him from other mammals. The apotheosis today is that we can perform Prokofiev’s music, enjoy Shakespeare’s poetry, dance to the rhythm of Bruno Mars, fly a plane, use a smartphone and delve into the secrets of the brain.

How we sleep and what quality sleep means?

Scientists have found that a person’s sleep is divided into two phases. When we sleep, there are times when our eyes move quickly under the eyelids. This period is called the phase of rapid eye movements, or REM (Rapid Eye Movement); it coincides with dreams. Another phase in which the eyes remain at rest is called NREM (Non-Rapid Eye Movement). No dreams occur at this time. 

The alternation of these phases of REM and NREM is formed in the late intrauterine period when the human fetus is in a state of sleep 95 percent of the time. Such a prolonged sleep in the fetus is ensured by warm and soft enveloping of the inner wall of the uterus, as well as the calming and sleeping pills of the chemicals produced by the placenta, such as adenosine, pregnanolone, and prostaglandins. An important role is played by the fact that the intrauterine environment is characterized by a low oxygen concentration, which is equivalent to the composition of the air on top of Mount Everest.

Does human fetus have any dreams at this time? Most likely not, since it is unlikely that a fetus enclosed in an isolated space could experience any impressions, and therefore dreams. The brain wakes up at the moment of birth when the fetus is pushed out of the heavenly watery environment of the mother’s womb into a hostile air and cold environment with alien sounds, smells and numerous stresses. According to Hugo Langerganz, a pediatrician at the University of Carolina, Sweden, the process of birth in a fetus is accompanied by a massive release of the stress hormone norepinephrine, with such power that in adults would be comparable to the first minutes of a parachute jump. To this should be added a disconnection from natural anesthetics and sedatives produced by the maternal placenta.

With the development of the child and the formation of the functions of cognition and imagination, visual-spatial experience and memory, the child begin to dream. According to neurophysiologists, at first, these dreams are quite primitive, flat, static, without any motor impressions. Subsequently, already at preschool age, dreams become more dynamic, acquiring colors and three-dimensional space, reflecting memories of past events. 

In adults, during the REM phase, paralysis of almost all the muscles of the body occurs, with the exception of the diaphragm, which is responsible for breathing, as well as some smooth muscles of the digestive tract. While we sleep in this state, the brain emits a lot of impulses (characterized as an "electric storm"), causing rapid eye movements - hence, in fact, the name of this phase of sleep. At the same time, we have colorful dreams. During the night we see dreams on average about three to five times. During dreams, an erection occurs in men, and in women, the blood vessels of the vagina are filled. These phenomena are in no way associated with erotic sensations; most likely, this phenomenon is due to physiological processes associated directly with sleep.

Sleep is considered good when NREM-REM cycles replace one another five times a night. And this has a biological meaning, which is to optimize brain activity. Initially, sleep begins with the NREM phase, in which excess and unwanted connections between neurons (brain cells) are removed from the brain. After such a period of purification, the REM phase begins, when the useful connections between the neurons are fixed.

These processes can be described by analogy with sculpting sculptures. First, the extra shapeless chunks of unnecessary memory - old and new (NREM phase) are removed - and the original form of useful consciousness (REM phase) is cast. The next cycle begins with the removal of smaller “pieces” of excess memory (the second phase of NREM), as a result of which the useful consciousness begins to take on a reasonable shape. Ultimately, all the pieces (large and small) of unnecessary memory are completely removed and the working consciousness is polished in its pure form, from which the day begins after awakening. And how important it is to start the day with clear thoughts - everyone knows. 

Some scientists believe that such an alternation of the phases of sleep is extremely important for improving consciousness, getting rid of thoughts that traumatize the thought process, adversely affecting health, or getting used to them. It is not in vain that medicine introduces seriously injured patients into medical sleep and even artificial coma.

It is also assumed that the REM phase is associated with a period when sound thoughts come to mind. Many cultures tend to understand when it is better to sleep with a problem and wake up with a rational thought about solving it. No wonder they say that "morning is wiser than the evening." Creative people, during sleep, come up with creative, sometimes brilliant ideas. Probably for them, the REM phase means “shaking” the brain in order to throw prosaic thoughts into the background. 

Why are we sleeping and how to be "owls"?

The biology of sleep and wakefulness is not simple enough and involves a wide variety of nerve impulses and chemical mediators. The mechanisms that trigger sleep and awakening are associated with the work of peculiar sensors and biological clocks. Just like in a car, we find out from the sensor that it is time to fill the gas tank, there is a special sensor in the body that, after 14 hours of waking up, reminds us that the time is approaching to go to sleep. The role of such a sensor in the human body is played by the chemical substance adenosine, which accumulates during wakefulness and puts us to sleep as we accumulate. The more time we stay awake, the more we accumulate adenosine and the more we want to sleep. The secret to the invigorating effect of caffeine is its ability to block the cellular receptors of adenosine.

Our biological clock works in such a way that helps to synchronize the individual need for sleep with the rhythm of life of the world around us. The main regulator is daylight. When light enters the retina, a signal immediately arrives at a special part of the brain called the suprachiasmatic nucleus. It is he who is responsible for maintaining the biological cycle, an alternating phase of sleep with phases of wakefulness. It is called the circadian rhythm. When dusk sets in, a substance called melatonin is released in the brain that makes us drowsy. It is interesting to note that people with eye injuries often suffer from sleep disturbances, while people with unharmed eyes do not experience this, even when the part of the brain responsible for visual perception is affected. 

By the way people sleep, they are divided into two categories: "morning larks" who prefer to get up early and go to bed early, and "nocturnal owls", prone to late awakening and staying up late. Moreover, it is their biological characteristics that have nothing to do with the reluctance of "owls" to work or a tendency to a serene lifestyle. However, many societies have developed a stereotype according to which "owls" are often considered lazy, preferring to soak in bed instead of "working as they should in advance." It's just that the “larks” are very lucky due to the fact that the labor rhythm in the modern world and even school schedules are tailored to those who tend to get up early. “Owls” have to radically change their biological rhythm in order to remain in order. Since life also often freezes early in the evening, when the “owls” are still full of energy and creative mood, for them, as they say, “the candle is burned from both sides.” With this situation, it is likely that owls are more likely to suffer from depression and anxiety, leading to cardiovascular disease, diabetes, and even cancer. 

How to ensure full sleep?

The fight against insomnia has a long history, including from ancient times such means as nutmeg, dandelion, onions, and lettuce. The belief about the sleeping pills of certain types of food was also widespread according to the Aristotelian belief that "the warm vapor of digested food reaches the brain, helping to euthanize it." In the modern world, the whole sleep industry has developed in the form of sedative-hypnotic drugs, numerous gadgets, “smart pajamas”, “smart pillows” and bioceramic gels designed to cool the body and thereby help to fall asleep. Even devices have been developed that synchronize breathing with "neuroacoustic" sounds or immerse the body in a special electromagnetic field, supposedly designed to restore the body, exhausted by insomnia.

Sleep is influenced by many factors, the most important of which is a hormonal balance. Insomnia in women can occur due to hormonal fluctuations during the menstrual cycle, as well as during menopause. In men, the nature of sleep largely depends on testosterone. During the period of the so-called "andropause" - a decrease in the concentration of testosterone in the blood - some men may experience insomnia.

One type of sleep disturbance is associated with a quick change of time zones during long flights. I recently celebrated my 100th transatlantic flight since my first trip to New York in 1991. An unpleasant sensation from such flights is what is called the Jetlag - a condition that is accompanied by insomnia and other unpleasant manifestations of discomfort. The term Jetlag is a combination of two English words: jet - "jet", lag - "delay". The creation of a jet engine revolutionized the massive movement of people around the planet. Crossing multiple time zones has become commonplace for hundreds of thousands of people. However, this is associated with a serious violation of our internal clockwork. 

I noticed that acclimatization is a little easier and faster when flying in a westerly direction, compared with flights to the East. Over the course of a couple of decades of such flights, I have developed useful rules for myself that greatly facilitate the portability of jetlag. When I fly westward (from Almaty or Astana to Europe or the USA), I try to sleep less, but rather read books, watch movies and eat light food. Upon arrival in the daytime, I recommend wearing sunglasses for a couple of hours, which can help with biological adaptation to the new time zone. At the same time, it is advisable to hold out as much as possible without falling asleep before dusk. During eastbound flights (from the USA or Europe to Almaty or Astana), I try to sleep more, closing my eyes and ears on the plane and asking the stewardesses not to wake me.

Sometimes it is difficult to control and completely protect yourself from factors that interfere with full sleep. However, it is possible to create conditions and develop habits that can help in this. 

How our ancestors slept?

One of the common problems is that most people think that a dream is only full when it lasts all night without interruptions. However, this is far from true. Unbeknownst to ourselves, we wake up several times during sleep, and each such awakening lasts only a few seconds. This is a normal phenomenon, which occurs on average 5 times during an hour's sleep. Scientists believe that we have borrowed such short awakenings from our ancestors in order to always be on the alert in case of unexpected attacks of predators. In addition, it is considered a protective mechanism against possible suffocation during sleep.

In fact, evolutionary sleep in humans was most often segmented, that is, intermittent. In the pre-industrial era, especially when there was no electricity, they usually went to bed at sunset. Most people's sleep was characterized by two stages: the initial, which was called "dead sleep", and the morning - a few hours before waking up. During the interval between them, which was more than an hour, people were awake, praying, having sex, sometimes even going out for a meal. Until now, in Brazil, Portugal, Greece, and some Mediterranean countries, restaurants have been preserved for this purpose, which opens at 2-3 o’clock in the morning. That is, segmented sleep (awakening in the middle of the night) is not a violation - it is rather a biological rhythm that we evolutionarily inherited from our ancestors. 

Before the advent of electricity, the nature of the sleep of our ancestors was mainly determined by the alternation of accessibility and lack of daylight. For example, at early dawn, milked cows and other domestic animals. Shepherds guarded the sheep against predators to the corral in the stall in the late evening - closer to sunset. All these processes often alternated with various religious rituals that have survived to this day. In Islam, starting at dawn, the muezzin urges believers to pray five times a day. In Judaism, it is customary to pray three times - in the morning, in the afternoon, and at night. In a famous passage from the Easter Haggadah, the student addresses five rabbis who have been discussing the Exodus all night, telling them that the time has come for the morning Shema. Among the Catholic monks, nuns and consecrated Catholic laity, the liturgy of the clock indicates prayers every three hours, from Lauds,

In the modern world, midnight is not the same midnight as it was even a couple of decades ago. Many of us continue to check emails or post to Facebook at 12 a.m. and we must admit that for many this continues well after midnight. Late falling asleep is often not compensated by an adequate morning sleep. If we add to this the evolutionarily inherited segmentation of sleep, then one should not be surprised at the current scale of the problems associated with insomnia and other sleep disorders.

People have always been tormented by the contradiction between the longed-for passion of "wild nights" and the desire to pacify the gardens of paradise. The many challenges of modern life with its responsibilities, concerns, and anxieties - in a permanent conspiracy against quality sleep, which is extremely important for health and quality of life. After all, even God himself decided to rest on the seventh day of the creation of the world.